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Psychotherapy

Chapter 9: INDEX
By Hugo Münsterberg
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This work presents psychotherapy as the deliberate treatment of illness by influencing mental life, distinguishes it from psychiatric care, and roots practice in psychological and brain-based theory. It outlines theoretical foundations including suggestion, hypnotism, and the subconscious, then turns to practical matters: the scope of psychotherapeutic application, general and special methods, and the assessment of mental and bodily symptoms amenable to mental treatment. It further examines the relationship of psychotherapeutic practice to religious institutions, physicians, and the wider community, arguing for systematic scientific study and formal psychological training in medical education while warning against uncritical mysticism and amateur practice.

Still more complex is the criminological problem. It sounds like an easy remedy for the greatest social calamity, if it is proposed simply to hypnotize the criminal and to supplant his antisocial will by a moral one. And if the absurdity of such a proposal is recognized it seems to many justified to demand such an intrusion at least in the case of the born criminal, even if the occasional criminal cannot be reached. But the conception of the born criminal is also only a label which is superficially used for a great variety of minds. That men are born with a brain which necessarily produces criminal actions is not indicated by any facts. The varieties which nature really produces are brains which are more liable than others to produce antisocial actions. We recognized from the start that the abnormal mind never introduces any new elements but is characterized only by a change of proportions. There is too much or too little of a certain mental process and just for that reason there must be a steady and continuous transition from the normal to the entirely abnormal. Here again we have not a special class of brains which are criminal; but we have an endless variety of brains with a greater or smaller predisposition for antisocial outbreaks. The variations which produce this criminal effect may lie in most different directions.

The brain may be for instance inclined to overstrong impulses, so that any desire rushes to action before the inhibiting counter-idea gets to work. Or, on the other hand, the brain may have unusually weak counter-ideas so that even a normal impulse does not find its normal checking. The fact that selfish and thus antisocial desires awake in the mind is not abnormal at all; only if they are not normally inhibited, the disturbance sets in. Furthermore the associative apparatus of the brain may work especially slowly; it may thus bring it about that the counteracting ideas do not arise in time. Or the emotions of a person may be unusually strong. Or there may be strong suggestibility, by which a bad example or a strong temptation has especially easy access. Or there may be negative suggestibility, by which a moral admonition stirs up a vivid idea of the opposite. In short, there may be a large number of factors, sometimes even in combination, each one of which increases the chances that the individual may come in danger in the midst of developed society. Yet no one of those factors involves just the necessity of crime. The same kinds of brains might simply show stupidity or credulity or inconsiderateness or brutality or stubbornness or egotism, and might by each of those factors decrease their chances in the community without directly running into conflict with the law. The criminal is therefore never born as such. He is only born with a brain which is in some directions inefficient and which thus, under certain unfavorable conditions, will more easily come to criminal deeds than the normal brain.

With the idea of a stereotyped born criminal there disappears also the idea of a uniform treatment against criminal tendencies. That men are different in their power of resistance or in their power of efficiency or in their intellect or in their emotions, we have to accept as the fundamental condition with which every society starts. It would be absurd to remodel them artificially after a pattern. The result would be without value anyhow, inasmuch as our appreciation is relative. No character is perfect. The more the differences were reduced, the more we should become sensitive even for the smaller variations. All that society can do is, therefore, not to remodel the manifoldness of brains, but to shape the conditions of life in such a way that the weak and unstable brains also have a greater chance to live their lives without conflicts with the community.

The situation is different as soon as the particular surroundings have brought it about that such a brain with reduced powers has entered a criminal career. The thought of crime now becomes a sort of obsession or rather an autosuggestion. The way to this idea has become a path of least resistance, and as soon as such an unfortunate situation has settled itself, the chances are overwhelming that a criminal career has been started. If such cases should come early to suggestive treatment which really would close the channels of the antisocial autosuggestion, much harm might be averted. Yet again the liability of the brain to become antisocial would not have been removed, and thus not much would be secured unless such a person after the treatment could be kept under favorable conditions. With young boys who through unfortunate influence have caught a tendency, for instance, to steal, and where the fault does not yield to sympathetic reasoning and to punishment, an early hypnotic treatment might certainly be tried. I myself have seen promising results. But if the impulse has irresistible character in such a way that the good will is powerless, we are again in the field of disease and the point of view of the physician has to be substituted for that of the criminologist.

Whether pedagogy and criminology are to make use of the services of psychotherapy is thus certainly an open question. It would be short-sighted to overlook the serious obstacles which stand in the way. But while the social life outside of the circle of real disease may better go on without direct interference by psychotherapeutic influences, it is certainly the duty of the community to make the underlying principles of psychotherapy useful for the sound development of society. The artificial over-suggestions which are needed to overcome the pathological disturbances of mental equilibrium may be left for the cases of illness. But we saw that every mental symptom of disease was only an exaggeration of abnormal variations which occurred within the limit of health. To reduce these abnormalities means to secure a more stable equilibrium and thus to avoid social damages, and at the same time to prevent the growth of the abnormality to pathological dimensions. To counteract these slighter variations, these abnormalities which have not yet reached the degree of disease, will demand the same principles of treatment, only in a weaker form. It is in a way not psychical therapy but psychical hygiene. And this is no longer confined to the physician but must be intrusted to all organs of the community. And here more than in the case of disease, the causal point of view of the physician ought to be brought into harmony with the purposive view of the social reformer, of the educator and of the moralist.

The ideal of such mental hygiene is the complete equilibrium of all mental energies together with their fullest possible development. To work towards this end does not mean to aim towards the impossible and undesirable end of making all men alike, but to give to all, in spite of the differences which nature and society condition, the greatest possible inner completeness and outer usefulness. The efforts in that direction have to begin with the earliest infancy and are at no age to be considered as finished; the whole school work and to a high degree the professional work has to be subordinated to such endeavor. Society has further to take care that those spheres of life which stand less under systematic principles, such as the home life of the child and the social life of the man, his family life and his public life, are steadily under the pressure of influences which urge in the same direction.

Harmonious development without one-sidedness, and yet with full justice to the individual talents and equipments, should be secured. That means from the start an effort to secure balance between general education and particular development. The latter has to strengthen those powers by which the boy or girl by special natural fitness promises to be especially efficient and happy. It has to be supplemented later by a wise and deliberate choice of such a vocation as brings these particular abilities most strongly to a focus. Yet this alone would mean a one-sidedness in which the equilibrium would be lost. More important, it would leave undeveloped that power which the youth especially needs to acquire by serious education, the power to master what does not appeal to the personal likings and interests. An equilibrium is secured only if at the same time full emphasis is given to the learning and training in all which is the common ground of our social existence. From the multiplication table to the highest cultural studies in college, the youth is to be adjusted to the material of our civilization without any concession to the emasculating desire to adjust civilization simply to the particular youth. He has to learn learning and not only to play with knowledge, he has to learn to force his attention in adjustment to those factors of civilization which are foreign to his personal tendencies and perhaps unsympathetic. Free election of life's work and unyielding mental discipline in the service of the common demands should thus steadily coöperate. The one without the other creates a lack of mental balance which is the most favorable condition for a pathological disturbance.

The mere learning is of course on both sides only a fraction of what the community has to develop in the youth. Mental hygiene begins with physiological hygiene. The nourishment of the child, the care for the child's sense organs, the recesses and the rest from fatigue, and especially the undisturbed sleep are essential conditions. The interferences with sufficient sleep are to a high degree responsible for the later disturbances of the mental life. It must not be forgotten that the decomposition of the brain molecules can never be restituted by anything but rest, and ultimately by sleep. Physical exercise is certainly not such restitution. In the best case it brings a certain rest to some brain centers by engaging other brain parts. The child needs sleep and fresh air and healthful food more than anything else, if his mind is active. The careful examination of the sense organs and of the unhindered breathing through the nose is most important. Even a slight defect in hearing may become the cause of an under-development of attention.

More important than mere physical hygiene is the demand that a sound character and a sound temperament are also to be built up, at the side of a sound interest. Here again everything depends upon a wise balance between the development of that which is given by nature to the particular individual and the reënforcement of that which society demands and which belongs therefore to the common equipment. The emotional stability and emotional enlargement of the mind is perhaps most neglected in our educational schemes. On the one side it demands a systematic discipline of the emotions, on the other a healthy stimulation of emotions. Here is the place where imagination in play and later in art come in. The biological value of play always lies in the training for the functions of later life, and especially for the emotional functions. The play of our children is too little adjusted to this task. For this reason it leaves too many unprepared for the world of art and for the emotional experiences of real life. Both lack of emotional discipline and narrow one-sidedness of emotions interfere with the harmonious development. Destructive emotions like terror ought to be kept away and not needlessly brought near by uncanny stories and mystic superstitions. It is the healthy love and sympathy of the home which contributes most strongly to the normal development of emotions. Again in the field of will, we want the strong, spontaneous, independent will which is not frightened by discomfort and not discouraged by obstacles, and yet we want the will which is not stubborn and selfish but which subordinates itself to the larger will of the social group and to the eternal will of the norm. There is no balance where independence and subordination do not supplement each other. A wide education not only trains for both but also secures habits which work as autosuggestions in both directions.

But all this harmonious development of intellect and temperament and character has to go on when the school days are over and just here begins the duty of the community as a whole. The special functions of the teachers have to be taken up by the public institutions. The whole social life must shape itself in such a way that everyone finds the best possible chances to perfect this harmonious growth. In the field of the intellect, the community must take care that thoroughness of training and accuracy of information is rigidly demanded and not thrust out by an easy-going superficiality. The expert ought to replace the amateur in every field. Every society which allows successes to superficiality diminishes its chances for mental health. Yet while thoroughness demands concentration in one direction, society must with the same earnestness insist on well-rounded general education and continuity of general interests through life. Literature and the libraries, the newspapers and the magazines play there a foremost rôle, and again the mental health of the community has to pay the penalty if its newspapers work against general culture. In the emotional field art and music, fiction and the theater on the one side, the church on the other side, remain the great schools for a development of sound emotions. Where literature becomes trivial, where the stage becomes degraded, and where the church becomes utilitarian and uninspiring, great powers for possible good in emotional education are lost. But with this enrichment of feelings the disciplinary influence too has to go through the whole social life. Where art is sensational and the church hysterical,—in short, where the community stirs up overstrong feelings,—the wholesome balance is lost again. In a similar way the public demands should throughout stimulate the energy and ambitions and initiative of the man, and yet should keep his desires and impulses in control.

Few factors are more influential in all these directions than the administration of law. Sound sober lawmaking and fair judgment in court secure to the community a feeling of safety which gives stability to emotions and feelings. The disorganization which results from arbitrary laws, from habitual violation of laws, from corruption and injustice works like a poison on the psychophysical system. A similar unbalancing influence emanates from overstrong contrasts of poverty and comfort. A poverty which discourages and leaves no chances and a wealth which annihilates the energies and effaces the consciousness of moral equality, create alike pernicious conditions for mental balance.

Unlimited furthermore are the influences which depend upon the sexual ideas of the society. It is the sphere in which it may be most difficult to indicate the way towards a development without dangers. There is no doubt the arbitrary suppression of the sexual instinct must be acknowledged as the source of nervous injury while indulgence may lead to disease and misery. But in any case frivolous habits and easy divorce contribute much to the unbalanced life which ruins the unstable individual. Not less difficult and not less connected with the mental hygiene is the alcohol problem. For normal adult men mild doses have through their power to relieve the inhibitions undeniable value for the sound development of the community. Its intemperate use or its use by young people and by pathological persons is one of the gravest dangers. Whether intemperance ought to be fought by prohibition or rather by an education to temperance is a difficult question in which the enthusiastic women and ministers, backed by the well justified fears of psychiatrists, will hardly be on the same side as the sober judgment of scientists, unprejudiced physicians, and historians. In any case the saloon and its humiliating indecency must disappear and every temptation to intemperance should be removed. Above all, from early childhood the self-control has to be strengthened, the child has to learn from the beginning to know the limits to the gratification of his desires and to abstain from reckless over-indulgence. With such a training later on even the temptations of alcoholic beverages would lose their danger. Not less injurious than the strong drinks are the cards. All gambling from the child's play to the stock exchange is ruinous for the psychophysical equilibrium. The same is true of any overuse of coffee and tea and tobacco, and as a matter of course still more the habitual use of the drugs like the popular headache powders and sleeping medicines. The life at home and in public ought to be manifold and expansive but ought to avoid over-excitement and over-anxiety. A good conscience, a congenial home, and a serious purpose are after all the safest conditions for a healthy mind, and the community works in preventive psychotherapy wherever it facilitates the securing of these three factors.

For that end society may take over directly from the workshop of the psychotherapist quite a number of almost technical methods. Suggestion is one of them. The means of suggestion through education and art, through the church and through public opinion, through example and tradition, and even through fashion and prejudices, are millionfold, but not less numerous are the channels for antisocial and antihygienic suggestions. No one can measure the injury done to the psychophysical balance of the weaker brains, for instance, by the sensational court gossip and reports of murder trials in the newspapers for the masses. But while the influence of suggestion is on the whole familiar to public opinion, the community is much less aware of another factor which we found important in the hands of the psychotherapist. We recognized that mental disturbances were often the result of suppressed emotion and repressed wishes. For the cure the psychotherapist has to aim toward the cathartic result. The suppressed ideas had to be brought to consciousness again and then to be discharged through vivid expression. Society ought to learn from it that few factors are more disturbing for the mental balance than feelings and emotions which do not come to a normal expression. It is no chance that in countries of mixed Protestant and Catholic civilization, the number of suicides is larger in Protestant regions than in the Catholic ones where the confessional relieves the suppressed emotions of the masses. This is also the most destructive effect of social and legal injustice; emotions are strangulated and then begin to work mischief. The community should take care early that secret feelings are avoided, that the child is cured from all sullenness which stores up the emotion instead of discharging it. Certainly all education and social life demands inhibition and also the child has to learn not to give expression to every passing feeling. To find there the sound middle way is again the real hygienic ideal. Too much in our social life and especially in the sphere of sexuality forces on the individual a hypocrisy and secrecy which is among the most powerful conditions of later mental instability.

Of course the background of a hygienic life of the community remains the philosophy of life which gives unity to the scattered energies and consequently steadiness to the individual through all his hazards of fate. It might seem doubtful whether society could get the prescription for such a steady view of the world also from the workshop of the psychotherapist. To the superficial observer the opposite might seem evident, as every word of our psychotherapeutic study indicated that that is a view of life which makes man's inner experience simply an effect of foregoing causes. All life becomes a psychophysical mechanism and from that point of view man's thinking and acting become the necessary outcome of the foregoing conditions. Nothing seems more unfit to give a deeper meaning to life and a higher value. And yet if there was one thought which controlled our discussion from the beginning, it was certainly the conviction that this causal view itself is only an instrument in the service of idealistic endeavors; the reality of man's life is the reality of will and freedom directed towards ideals. One of these ideals is the reconstruction of the world in the thought forms of causality. In the service of our ideals we may thus transform the world into a mechanism: out of our freedom we desire to conceive ourselves as necessary products. Whenever we aim to produce changes in the world, we must calculate the effects through the means of this causal construction, but we never have a right to forget that this calculation itself is therefore only a tool and that our reality, in which our duties and our real aims lie, is itself outside of this construction. The psychotherapist wants to produce effects inasmuch as he wants to cure disease. He is therefore obliged to adjust his work as such entirely to the causal aspect of man, as soon as he wants to seek the means by which he can reach the end. But even the fact that he decides in favor of those ends, that he aims towards their realization, binds him to a world of purposes, and therefore, he, too, with his whole psychophysical work, stands with both feet in a reality of will which is controlled not by causes but by purposes, not by natural laws but by ideals.

INDEX